Optical Coherence Tomography as a Predictor of Visual Protection and Recovery in the Setting of Pituitary Apoplexy

Objective: Pituitary apoplexy is a clinical condition resulting in neurological and pituitary dysfunction as a result of pituitary tumor infarction or hemorrhage. Surgery is often recommended in the setting of acute visual loss. Preoperative RNFL thickness has previously been shown to be a prognosticator for long-term visual recovery following pituitary or parasellar tumor resection. The authors investigated if perioperative optical coherence tomography (OCT) could be used as a prognosticator of visual outcomes in pituitary apoplexy.

Methods: The authors retrospectively reviewed the medical records of 41 patients who had presented to their institution with pituitary apoplexy from 2013 to 2022. Six patients were identified that had perioperative optical coherence tomography in combination with Humphrey visual fields. All patients underwent preoperative MRI demonstrating pituitary apoplexy. All six patients underwent endoscopic transsphenoidal resection of their pituitary tumor. Humphrey visual fields were completed perioperatively and in the postoperative period to assess visual outcomes.

Results: Maximal tumor diameter in the craniocaudal dimension was 3 cm (average: 2.28 cm). Optic chiasm compression by hemorrhagic tumor was seen on MRI in all but one patient (83%). Surgical intervention timeframe ranged from <24 hours to 10 days following apoplexy. Retinal nerve fiber thickness (RNFL), as measured by OCT, was found to be above 72 µm (range OD: 72.25–102.5 µm and OS: 73.25–100 µm) in all patients. One patient was found to have acute bitemporal visual loss as measured by Humphrey visual fields (OD: -18.09 and OS: -12.72 dB). Average RNFL thickness was normal in this patient (OD: 86 µm and OS: 86 µm). Repeat visual fields 7 months later demonstrated complete normalization of vision (OD: 1.57 and OS: 1.67 dB). Mild temporal field defects as measured by Humphrey visual fields were noted to improve and normalize at 6 to 12 months in 3 other patients (50%). No visual field defects were seen in 2 patients (33%) at the time of apoplexy presentation and continued to be normal throughout follow-up.

Conclusion: Neurological deficits following pituitary apoplexy include acute and long-term vision loss. All patients in our series had normal average RNFL thickness as measured by OCT. All four patients presenting with visual loss had recovered by 1 year. RNFL thickness may be a good prognosticator for visual recovery and visual protection in acute vision loss as a result of pituitary apoplexy.

Publication History

Article published online:
01 February 2023